Healthcare Provider Details

I. General information

NPI: 1548930498
Provider Name (Legal Business Name): STEPHANIE MARIE COLLADO PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: STEPHANIE MARIE ORTIZ

II. Dates (important events)

Enumeration Date: 09/13/2021
Last Update Date: 10/29/2024
Certification Date: 10/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2080 OAKLEY SEAVER DR STE 120&130
CLERMONT FL
34711-1962
US

IV. Provider business mailing address

2080 OAKLEY SEAVER DR STE 120&130
CLERMONT FL
34711-1962
US

V. Phone/Fax

Practice location:
  • Phone: 321-841-6444
  • Fax: 407-650-1307
Mailing address:
  • Phone: 321-841-6444
  • Fax: 407-650-1307

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA9115127
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: